Impella-assisted high-risk PCI showed similar one-year mortality but significantly reduced myocardial infarction (1.4% vs. 10.9%) compared to PCI without mechanical circulatory support.
Does Impella-assisted high-risk percutaneous coronary intervention reduce one-year adverse clinical outcomes compared to high-risk PCI without mechanical circulatory support?
In a propensity-matched registry analysis, Impella-assisted high-risk PCI was associated with similar one-year survival but a significantly lower rate of myocardial infarction compared to PCI without mechanical circulatory support.
Abstract Background Impella is increasingly used as mechanical circulatory support (MCS) during high-risk percutaneous coronary interventions (HR-PCI). Registry-based data provide insights into the efficacy and safety of Impella-assisted HR-PCI, until randomized evidence is available. Objectives We evaluated one-year outcomes of Impella-assisted HR-PCI compared to HR-PCI without MCS. Methods One-hundred thirty-eight patients undergoing Impella-assisted PCI included in the IMPELLA-PL registry were propensity score matched with controls from the CardioSilesia registry who underwent HR-PCI without MCS. Study endpoints included one-year post- discharge all-cause mortality, myocardial infarction (MI), stroke, rehospitalization for heart failure (HF), and repeat coronary revascularization. Results Clinical and angiographic characteristics were comparable in both groups, with higher rates of dyslipidemia (78.3 vs. 37.7%, p0.001), chronic kidney disease (39.9 vs.16.7%, p0.001), and peripheral artery disease (34.1 vs. 8.0%, p0.001) in the IMPELLA-PL cohort. Intravascular ultrasound was more frequently used in the Impella-supported patients (44.2 vs. 25.4%, p=0.002), while staged revascularization was more common among controls (30.4 vs. 15.9%, p=0.007). At one year, rates of post-discharge all-cause mortality, stroke, and repeat coronary revascularization were similar in both groups. MI was less frequent in the IMPELLA-PL cohort (1.4 vs. 10.9%, p=0.003), alongside a trend towards lower incidence of rehospitalizations for HF (9.4 vs. 18.1%, p=0.055). Conclusions Despite unfavorable cardiovascular risk profile, patients from the IMPELLA-PL registry who underwent Impella-assisted HR-PCI had similar one-year survival, with a lower rate of MI, compared to propensity score-matched controls who underwent HR-PCI without MCS. Impella may improve HR-PCI outcomes, but randomized data are required to confirm this finding.Graphical AbstractFor image description, please refer to the figure legend and surrounding text.
Blazejowska et al. (2026) studied this question. Impella-assisted high-risk PCI showed similar one-year mortality but significantly reduced myocardial infarction (1.4% vs. 10.9%) compared to PCI without mechanical circulatory support.